Second Opinions on Obama’s Medicare Plans

Jonathan Cohn

First posted 9/20/11 on Citizen Cohn, Jonathan Cohn’s blog at the New Republic site.

The numbers in President Obama’s new plan for health care spending can be confusing, so how about a picture? Or, at least, a pie chart? The terrific one you see comes from Igor Volsky, at Think Progress, and it breaks down the sources of Medicare savings in the deficit reduction package.

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Why IPAB Is Essential

Jonathan Cohn

First posted 7/29/11 on Kaiser Health News

A little over two weeks ago, while most of you were paying attention to the debate about how to raise the debt ceiling, those of us who study health care policy were following hearings before the House Budget Committee. The purpose of the hearings was to scrutinize the Independent Payment Advisory Board, a commission that the Affordable Care Act created as part of its apparatus to control health care costs. And the hearings produced some genuinely interesting testimony on everything from the scope of the board’s authority to the limits of its legal power. If we were in the middle of a dialogue about how to improve the board’s structure and function, that testimony would be extremely useful.

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Are You Better Off With Medicaid Than With No Insurance? A Landmark Study Says Yes.

Jonathan Cohn

First posted 7/7/11 on Kaiser Health News

Are you better off with Medicaid than if you had no insurance at all? The answer seems like a no-brainer: Of course you are. But, for the last few months, a cadre of conservative writers and intellectuals has argued that the program doesn’t actually help beneficiaries and may actually hurt them. To prove their point, they’ve cited a handful of studies in which Medicaid recipients ended up in worse health than people with no coverage whatsoever. According to Medicaid’s critics, this evidence suggests that expanding the program, as the Affordable Care Act would, is a bad idea.

Most social scientists I know reject these arguments. The reason: When you’re comparing people on Medicaid to people with no health insurance, there’s no simple, sure-fire way to account for the underlying differences in the two populations. For example, if you know you suffer from serious medical problems, you’re more likely to sign up for public insurance when it’s available. As a result, the Medicaid population may be fundamentally sicker than the uninsured population — and end up with worse medical outcomes, even if they’re benefiting from the program’s coverage.

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About That McKinsey Report…The Critics Were Right

Jonathan Cohn

First published 6/23/11 on Kaiser Health News

McKinsey and Company has finally released the details of its controversial paper on the likely effects of health care reform. And it looks like the paper’s critics (including yours truly) were right to raise questions about it. Based on what the company has said, the paper offers no new reason to think Americans with employer-sponsored insurance will lose that coverage because of the Affordable Care Act.

Politically, that’s good news for President Barack Obama, since he told insured Americans that the law wouldn’t take away the coverage they already had. But what does it mean in terms of policy? Should we be happy that health care reform is unlikely to reduce substantially the current system’s dependence on employer-based insurance? That’s another, much more complicated question.

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Another Day in Court for the Individual Mandate

Jonathan Cohn

First published 6/8/11 on Kaiser Health News

Opponents of the Affordable Care Act had another day in court on Wednesday, this time before federal judges in Georgia, representing the 11th Circuit Court of Appeals. These opponents want the judges to uphold a ruling, made by a lower federal judge in Florida, that the law is unconstitutional. It’s the third such appeal to go before a Circuit Court — and perhaps a prelude to consideration before the Supreme Court.

As you probably know, the primary focus of the plaintiffs in these lawsuits is the “individual mandate” — the requirement that all people with economic means contribute toward the cost of their health care by obtaining insurance or paying a tax penalty. The constitutional objections to this scheme are varied and complicated. But one argument by the plaintiffs deserves extra scrutiny, because it suggests the plaintiffs misunderstand health care policy, are misapplying a crucial court precedent, or some combination of the two.

The argument is about Article I, Section 8 of the Constitution, which empowers the federal government “to regulate commerce … among the several states.” The Commerce Clause, as it is known, is one of three constitutional provisions that the government has cited as justification for imposing the individual mandate. And its origins should be familiar to anybody with even rudimentary knowledge of American history. In the first years after independence, the country’s governing charter was the Articles of Confederation, in which state autonomy hindered security and hobbled prosperity.

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Misinformation on the IPAB

Merrill Goozner

First published 6/9/11 on Gooz News

David Brooks’ op-ed in the New York Times earlier this week attacking health care reform’s Independent Payment Advisory Board has set off a mini-firestorm in the liberal blogosphere. Brooks claimed IPAB would impose centralized planning over health care decision-making, while the alternative Republican plan — vouchers — would let consumers decide how much insurance and how much health care they should buy. Brooks went on to say the fight over IPAB will be a defining battle between the two ideologies contending for power in the U.S. — decentralized free-market choice and centralized planning.

Whew. That’s an awful lot of baggage to pile onto a board that the Congressional Budget Office says will pare all of $15.5 billion from overall Medicare spending between 2015 and 2019. For those keeping score, that compares to $400 to $500 billion in other Medicare cost reductions in the reform law.

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High Deductible Plans: When Spending Less on Health Care Isn’t Always Good News

Jonathan Cohn

First published 3/30/11 on Kaiser Health News

Conservatives think traditional health insurance provides too much financial protection from medical expenses. They also think that the Affordable Care Act will make this situation worse. That’s one reason they want to repeal it.

The problem, according to the conservatives, is that insurance dulls the average person’s consumer instincts. When medical care is cheap or free, people don’t bother to shop around for the best prices — and they don’t think twice before seeing the doctor. In other words, they end up with too much care at too high a price. Insurance and government programs spread that cost around, so that eventually all of us end up paying more in the form of higher premiums or taxes over which we have little individual control.

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An Open Question


When Jonathan Cohn looks at the legal challenges to the ACA, he doesn’t see judicial restraint:

What bothers me (well, one of the things that bothers me) is that so many critics of the Affordable Care Act act as if it is the individual mandate itself, not their interpretation of the constitution, that represents a radical break with the past. I just don’t see that and neither, apparently, do a lot of other people who follow the law more closely than I do.

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Is Richard Foster Right About Health Care Costs


Originally published 2/2/11 on Kaiser Health News

Last week, before a lower federal judge in Florida declared the Affordable Care Act unconstitutional, another relatively obscure government figure generated news about health care reform. It was Richard Foster, the chief actuary at the federal agency that runs Medicare and Medicaid.

During a Capitol Hill hearing, Foster was asked to judge claims that the health law would “hold down costs.” Foster said he thought the claim was “false … more than true.” Critics of the overhaul seized on his comments as proof that they have been right — and proponents have been wrong — about the law’s fiscal impact.

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The Avastin Decision: A Rational Decision Or Rationing?


This column is a collaboration between KHN and The New Republic.

Originally published 1/04/11 on Kaiser Health News

I respect honest disagreements about policy. You think health care reform is a bad idea? That it will run up the deficit or make it harder to find a doctor? I think you’re wrong, but that’s a reasonable debate and I’m happy to have it, just as long as you’re truthful about what you are arguing and make some good faith effort to learn the facts.

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